- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.88 / $56.63 / $110.32
| Facility | | $11.88 | $56.63 | $110.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.88 / $11.88 / $11.88
| Professional | | $11.88 | $11.88 | $11.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.67 / $69.30 / $158.44
| Professional | | $12.67 | $69.30 | $158.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.75 / $26.78 / $57.14
| Facility | | $25.75 | $26.78 | $57.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.60 / $18.17 / $22.72
| Professional | | $8.60 | $18.17 | $22.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.20 / $32.20 / $32.20
| Professional | | $32.20 | $32.20 | $32.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.74 / $9.50 / $14.41
| Professional | | $7.74 | $9.50 | $14.41 |